| Background and Objective:The esophageal cancer has high incidence and mortality in China, which isaccounting for70%of the esophageal cancer world wide and is the fourth cause ofcancer related death in China. More than90%of patients with esophageal cancer inour country were squamous cell carcinoma. Radical surgery is the standard treatmentfor patients with resectable local advanced esophageal cancer. In recent years, theefficacy of surgery is still far from satisfactory, although the operative techniques hadbeen improved. It seems to have reached a bottleneck period. According to theprevious data, the5-year survival rate was20.64%-34.0%in stage IIA-IIIesophageal cancer patients who underwent esophagectomy alone. The main cause ofdeath after surgery was local recurrence or distant metastasis. Most of studies hadshown that multimodality therapy could improve treatment efficacy of esophagealcancer.There was almost a consensus that neoadjuvant therapy can improve survivalbenefit in local advanced esophageal cancer which was unable to resect radically atdiagnosis, but the efficacy of adjuvant therapy for esophageal cancer patients was stillcontroversy.The purpose of this study was to explore the effectiveness of adjuvant therapy inlymophode positive (pN1), radically resected esophageal squamous cell cancer patientand its prognostic factors by retrospective analysis.Methods:We retrospectively analyzed the data of55N1lymph node-positive esophagealsquamous cell cancer patients who undergone esophagectomy in First Hospital ofJilin University during the period of between November,2007and November,2013.Of these patients,23patients received radical surgery alone,32patients receivedradical surgery following by adjuvant chemotherapy or adjuvant chemoradiotherapy. Analysised the clinical and pathological characteristics of all the patients wereevaluated,disease-free survival (DFS) and overall survival (OS) of patients in twogroups were calculated. The Kaplan–Meier method were used to estimate disease-freesurvival and overall survival. The Log-rank test was used to analyze the categoricalvariables.Multivariate and univariate analysis was accomplished with Coxproportional hazard regression. All the stastical analyses were performed by SPSS17.0. When the P <0.05value was considered as statistical significance.Results:1. DFS of the patients received surgery alone and the patients received adjuvanttherapy after surgery were9.4months and19.3months respectively(P=0.008), OS ofthe two groups were12.3months and23.4months, respectively (P=0.003)。2. Subgroup analysis showed that adjuvant chemotherapy after surgery had nosignificant effects on DFS17.3months vs9.4months, P=0.128), but it had a notableeffect on OS in patients with N1positive esophageal squamous cell carcinoma (23.4months vs12.3months, P=0.032), compared to patients with surgery alone.3. Subgroup analysis showed that DFS of the group who received adjuvantradiochemotherapy after surgery and the group who received surgery alone were19.3months and9.4months(P=0.012), OS of the two groups were24.7months and12.3months(P=0.010)。4. The univariate and multivariate analysis suggested that adjuvant therapy wassignificantly correlated with survival benefit in patients with N1positive esophagealsquamous cell carcinoma (Univariate analysis, DFS P=0.011,OS P=0.003,Multivariate analysis, DFS P=0.008,OS P=0.004).Conclusions:1. Compared to the patients with surgery alone, adjuvant therapy after surgerycan prolong the DFS and OS of patients with N1positive esophageal squamous cellcarcinoma(DFS P=0.008, OS P=0.003)。2. Subgroup analysis shows that adjuvant chemotherapy after surgery has nosignificant effects on DFS (P=0.128), but it has a notable effect on OS in patients withN1esophageal squamous cell carcinoma(P=0.032), compared to the patients with surgery alone.3. Subgroup analysis shows that patients with adjuvant chemoradiotherapy aftersurgery has a significant longer DFS and OS than the patients with surgery alone(DFSP=0.012,OS P=0.010）。4. The univariate and multivariate analysis suggest that adjuvant therapy issignificantly correlated with survival benefit in patients with N1esophageal squamouscell carcinoma(Univariate analysis,DFS P=0.011,OS P=0.003,Multivariate analysis,DFS P=0.008,OS P=0.004). |
